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PL-12-629Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 L.-- Inspection Number: INSP - 172231 Permit Number: PL -4 -12 -629 Scheduled Inspection Date: May 21, 2012 Inspector: Hernandez, Rafael Owner: SPROUT, ALISON Job Address: 10643 NE 10 Place Miami Shores, FL Project: <NONE> Contractor: STATEWIDE SEPTIC CONNECTIONS Permit Type: Plumbing - Residential Inspection Type: Final Work Classification: Drainfield Phone Number Parcel Number 1122320280550 Phone: (954)963 -0082 Building Department Comments INSTALL 900 SEPTIC TANK AND INSTALLATION OF 225 DRAINFIELD Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments HRS IN FILE May 18, 2012 For Inspections please call: (305)762 -4949 Page 17 of 38 04/26/2C12 09:37AM 954967q431 PAGE t • = Miami Shores Village D°172712)11 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. I 12:(19 � BYE PERMIT APPLICATION Master Permit No. FBC 20 [O Permit Type: PLUMBING Owner's Name (Fee Simple Titleholder) A 1, try ur` Phone # e)1 95--00g1 Owner's Address l Ca 4 NYE- 10 Pt City NI S tI P rcS State FL Tenant/Lessee Name Email Zip 3i3 Phone # Job Address (where the work is being done) ©043 NE (o PL City Miami Shores Village County Miami -Dade FOLIO / PARCEL # r k -- '61- 02_8- -O S Is Building Historically Designated YES NO, A Zip Flood Zone Contractor's Company Name S kkl +e 1(lc c Phone # 0S--- ( • 1-C6 3.) Contractor's Address 6o 2 3 S City FA 91,fi'ct Prksk r State 2 Zip O Z,'5 Qualifier Name 1-' S-- . Phone # State Certificate or Registration No. Certificate of Competency No. Contact Phone E -mail Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ O` Type of Work: ['Addition Describe Work: Square / Linear Footage Of Work: .2-is ❑Alteration ['New Repair/Replace [' Demolition (r� DcM -C _' , (;) S -hr-o- b �� d G Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Ni,,r1P Structural Review. $ Total Fee Now Due $ See Reverse side --> Bonding Co,mp}'s Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understd that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. r Agent The foregoing instrument was acknowledged before me this 1 0 The foregoing ' strument was ackno ledged before, day of Signature SQLQ„v-yir___ Contractor day of ,20 tr2- ,by PAN 'S.0 who is personally known to me or who has produced Dye( v/ . Lim r (Fti) As identification and who did take an oath. NOTARY PUBLIC: h rcsoi or who has produced as identification and who did take an oath. Sign: �� _' "C'`" Sign: Print: ` �' ��' c=kiikerSOLOMON Print: My Commission Expires: _; °: MY COMMISSION # EE131935 EXPIRES November 08, 2015 ,01)3060153 Fividalvote,yserwae.c m My Commissio 4 1 CI AttfIA V cuau I OS e i9 Notary Public - State of Florida = My Comm. Expires Sep 23, 2015 s Commission # EE 128810 ,,, °� i °ss' Bonded Through National Notary Assn. ****************************** ***************************************************************************** APPROVED BY ° f3 (7-- Plans Examiner Zoning (Revised 07 /10 /07)(Revised 06/10/2009) Engineer Clerk checked STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT CONSTRUCTION PERMIT FOR: OSTDS Repair APPLICANT: Alison Sprout PROPERTY ADDRESS: 10643 NE 10 PI Miami, FL 33138 LOT: 46 PERMIT #:13$C- 1403308 APPLICATION #: AP 1068253 DATE PAID: FEE PAID: RECEIPT #:. DOCUMENT #:PR872287 BLOCK: 4 SUBDIVISION: PROPERTY ID # : 11- 2232 -028 -0580 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 645 -6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THI$ PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ] GALLONS / GPD Septic A [ 0 ] GALLONS / GPD N [ 0 ] GALLONS GREASE INTERCEPTOR CAPACITY K [ ] GALLONS DOSING TANK CAPACITY CAPACITY CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] ]GALLONS @[ ]DOSES PER 24 RIBS #Pumps [ ] D [ 225 ] SQUARE FEET SYSTEM R [ 0 ] SQUARE FEET SYSTEM A TYPE SYSTEM: [x] STANDARD [ ] FILLED [ ] MOUND [ ] x CONFIGURATION: [x] TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: F.F.E.: 6.9 NGVD. I ELEVATION OF PROPOSED SYSTEM SITE ( 3.60 ] w INCBE° 1 FT 1 ( ABOVE 4 BEL0 .P BENCHMARK /REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 28.60 ] INCHES FT ] [ ABOVE4-1IBENCNMARK /REFERENCE POINT L D FILL REQUIRED: [ 0.00] INCHES 0 T H E R EXCAVATION REQUIRED: [ 25.00] INCHES 1— install 900 gal. septioc tank certified by" Statewide Septic Connections Inc" on 04/02/2012 to remain. 2- Install 225 sf of drainfield in trench configuration. 3- Perimeter of excavation area shall be at least 2 ft wider and longer than the proposed absorption trench. 4 -Invert elevation of drainfield to be no less than 4.43' NGVD. 5. Bottom of drainfield elevation to be no less than 3.93' NGVD. THIS PERMIT IS NOT FOR ADDITION(s). 3PECIFICATI NB°SY: Teresa J Solomon• ¢ �E TI ukba :tlsbto APP •�;% ci� gy• ___ Dade CND N opines DATE ISSUED: 04/092012 The contras EXPIRATION DATE: 07/08/2012 soil florin c� (or gr °igne�l z is r . DH 4016, 08/09 (Obeoletes all previodkned�, ce h a;,?,a orm a Incorporated: 64E- 6.003, FAC inspector shall n. Friar to Final ''on at ttt o i.1.4 r2s4!iS to sh nifr :6632.stil Pal and con, 4s reins a t the arranged .s, boring a +IYt corn Fection tee Icily to assessed t e contrted.F�re the at the jobsite . be °ss�sed if the contra not at the . rrangerr time. Page 1 of 3 41WATE dr *FLORIDA W DEPARTMENT OF HEALTH • APPLICATION FOR ONSITE SEWAGE DISPOSAL SYSTEM CONSTRUCTION PERMIT Permit Application Numb'er', • PART -SITE PLAN- Scale: Each block represents 5 feet and 1 Inch =50 feet. .k= =WNW •■••■ 2 . • • • • .• --s ; 7- I -• -t , • r ' i .1 • -• ' I : 7s, : L • 1 11 1 : = 1 . r L: i; - ..f• • • 1 _:_ . .- " - - • i ;•-•-•1 '--.1-;,-1.--Lt4.1"41. LI,. i_•_!„1_, i _1 f ;,..;;_i_; ,;', 1.- • 1 ,, ! I ;,_;_ I...LE.; 1 I I . L Sr( i....1, . A i . : .: , • ... : I . 1........ 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TV a _ .,... 1 UV __,9 --i- -T t. ■ , 1 ; --, • •• Iiii L:- 1 i : WU 1 .... 1111 ; 2 i , ; , 111 . a* a imii maifflur, i __ - -: I mar , 4 7_,,, ) 4 , Illt fillifUlfall 011 , ar . ; 44 wilitlif itamattstmut igilisour 3 m - - • LI UNIS*11111111Wd 111111111 no a . , : t 1 0 ail 4 1 str,*-, - ullr=WW l — 11' 1 1 . • W W WlWa W III I W i VlIUNUU NN I 1 _ ,• . ,„I K • . 1 a 111W • I IMMISUUMMUUR 1- a t 1 an i , , WaillitraldWiltill i : 111111WWWWWWWW1111111111. 1 SW 11. N i ' UURN,111•11131011 UUJI a 1 1 I 1111441/14M.;_ NUIVUMEMOUIMUUU I . .111, 411111K11 11 7111111. 1 I IU MM• IUKU710 IM- i s 1V. II Ut M a nc N m IWS1I U U W . „-111.1 § M ,, C ; . 4 an a i 1 • 4tftft- U WtiKItAa II i a •; 0 ..• 1*1 k ' a , 1 u -11" i sn11M1 s11i1a aaI s s Notes: , Site Plan submitted by: Plan Approved •By Not Appoved- I , • Tide Date County Health Departmerr ALL CHANGES MUST BE APPROVED BY THE COUNTY .HEALTH DEPARTMENT 004015. IONS (Replaces 0518-14 Farm 4015 width atay be used) (Stock Number: 5744402-40154 Page 2 of 3